WOFAPS 2025 8th World Congress of Pediatric Surgery

Charulata Devidas Naik, Archana Puri

VMMC and Safdarjang Hospital, New Delhi

Introduction: Despite advancements in the understanding of congenital pelviureteric junction obstruction(PUJO) pathophysiology , there remains a dilemma about the optimal timing of surgery. This study aims to evaluate the post pyeloplasty functional recovery relative to the age of patient at surgery.

Methods :This prospective observational study included 60 children of PUJO who underwent dismembered pyeloplasty. All children were operated as per standard guidelines. Pre- and post-operative evaluations involved ultrasonography and F0 diuretic renograms to study differential changes in parenchymal thickness (PT),ante riposte riot diameter (APD) and differential renal function (DRF). Significant functional recovery was defined as >5% increase in function. Children were categorized into two groups based on age at surgery: Group I (<1 year, n=30) and Group II (>1 year, n=30).

Results: The mean age of surgery is Group I -7.2 + 3.6months and Group II -82 + 44.4 months. Most Group I patients (n=23; 76%) were antenatally diagnosed, while Group II ( n=29 ; 96.6%) presented with symptoms ,primarily a lump(40%). Both groups showed normal renal function tests and blood pressure preoperatively, with comparable SFU grade of hydronephrosis(p-0.16), APD (p-0.61),PT(p-0.27) , DRF(p-0.01). There was no significant difference between groups in achieving >50% gain in PT(p-0.44) and decrease in APD (p-0.91) and >5% gain in DRF (p-0.86) post surgery. The DRF in each group showed significant increase - more in older children (Group I-p-0.04 and Group II - p< 0.005).

Discussion :The success of pyeloplasty was up to 96% in this study but no significant difference in anatomical and functional recovery was found as regards to age of surgery. We would recommend surgery in asymptomatic children only on deterioration of renal parameters and as per standard guidelines.